Valenti v. Paul Revere Life Insurance

14 Mass. L. Rptr. 373
CourtMassachusetts Superior Court
DecidedMarch 13, 2002
DocketNo. CA0000309
StatusPublished

This text of 14 Mass. L. Rptr. 373 (Valenti v. Paul Revere Life Insurance) is published on Counsel Stack Legal Research, covering Massachusetts Superior Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Valenti v. Paul Revere Life Insurance, 14 Mass. L. Rptr. 373 (Mass. Ct. App. 2002).

Opinion

Toomey, J.

INTRODUCTION

This matter is before the court on the motion of defendants Paul Revere Life Insurance Company (“Paul Revere”) and Unum Provident Corporation (collectively, defendants) for partial summary judgment in an action brought by plaintiff Denise Valenti (“Dr. Valenti”). In her action, Dr. Valenti alleges breach of a disability income insurance policy (Count One) and violation of G.L.c. 93A (Count Three). In addition, she seeks a declaration that she is totally disabled under the terms of a policy issued to her by Paul Revere (Count Two). Defendants seek summary judgment only on Count Two.

For the following reasons, the defendants’ motion is ALLOWED.

BACKGROUND

A. The Policy

Dr. Valenti purchased a disability income insurance policy from Paul Revere in June of 1992. At the time, she was employed as an optometrist, working one to two days a week as a clinical optometrist for Harvard Community Health Care (“Harvard Community”) and conducting a private homecare clinical optometry practice 2V2 to 3 days a week. The Policy provided for a total disability benefit and, under certain specified circumstances, a residual disability benefit based upon loss of income.

The dispute at bar arises primarily from the Policy’s definitions of “total disability” and “residual disability.” The pertinent policy provisions are:

Total Disability: “Because of Injury or Sickness . . . You are unable to perform the important duties of Your Occupation.”
Residual Disability: “Due to Injury or Sickness . . . You are unable to perform one or more of the important duties of Your Occupation or You are unable to perform the important duties of Your Occupation for more than 80% of the time normally required to perform them; and . . . You are not totally disabled.
Your Occupation: “The occupation or occupations in which you are regularly engaged at the time Disability begins.”

For an individual to make a claim for disability benefits, the Policy requires that “written proof of loss ... be sent to [Paul Revere] within 90 days after the end of each period for which the insured . . . claims benefits,” but in no event more than a year after the date such proof of loss was required. The Policy also contains a contractual limitations period barring any “legal action . . . after 3 years from the date of which proof of loss is required.”2

B. The Claim

On her June 1992, application for the Policy, Dr. Valenti listed her occupation as “Optometrist,” specifying the duties of her occupation as “70% home care optometry (home bound elderly) [and] 30% conventional [optometry].” In August of 1992, Dr. Valenti was diagnosed with a heart condition (Familial Dilated Cardiomyopathy) that required her to stop working as an optometrist.

On November 16, 1992, when Dr. Valenti filed a Statement of Claim in support of her request for total disability benefits, she again stated her occupation as “Optometrist.” On that statement, she listed the duties of her occupation, in order of importance, as:

(1) direct patient care to homebound . . . eye exams in patient’s homes, primarily elderly majority in inner-city Boston neighborhoods .. . , 3-5 visits per day, 2-3 days per week . . .
(2) transport . . . each exam requires equipment weighing 43 pounds, special procedures equipment weighs additional 10-30 pounds, majority patients 2-8 flights up, no elevators,
(3) paperwork and
(4) eye exams for Harvard Community.

Until February of 1993, Dr. Valenti filed monthly Progress Reports to provide continuing proof of loss. During that time, Paul Revere reviewed each monthly Report. After determining that Dr. Valenti remained totally disabled within the meaning of the Policy, as she claimed in each monthly Progress Report, Paul Revere issued Dr. Valenti a total disability payment for the preceding 30 days.

In her February 1993 Progress Report, Dr. Valenti indicated that, on February 18, 1993, she had re[374]*374turned to part-time work as an optometrist with Harvard Pilgrim (formerly Harvard Community). On that Report, she checked the box indicating that she was “unable to work” in her occupation. After receiving the February Report, Paul Revere sent Dr. Valenti a letter, on March 8, 1993, informing her that she was no longer eligible for total disability, but might quality for residual benefits. On her next Progress Report, dated April 11, 1993, Dr. Valenti indicated that she was “working in a limited capacity” in her occupation.

Dr. Valenti challenged the March 8, 1993 reduction in benefits, informing Paul Revere that she believed she was still entitled to total disability benefits because she was unable to practice homecare optometry. On May 24, 1993, Paul Revere sent Dr. Valenti a letter stating that, because her occupation included general optometry at Harvard Pilgrim, as well as her home healthcare practice, she was entitled only to residual benefits. Dr. Valenti, whose subsequent monthly Progress Reports indicated that she was “working in a limited capacity" in her occupation, accepted and cashed her monthly residual disability checks from February 1993 through March 1999. On March 10, 1999, after reviewing Dr. Valenti’s updated medical information, Paul Revere determined that she was able to practice optometry on a full time basis and terminated her residual benefits.

On February 15, 2000, Dr. Valenti filed this action, seeking payment of total disability benefits from February 1993 to the present, contending that she is totally disabled under the terms of the 1992 policy.3 By March 2001, Dr. Valenti was, according to her deposition testimony, performing eye examinations on behalf of Harvard Pilgrim approximately twenty-five hours per week.

DISCUSSION

Summary judgment will be granted where there are no material facts genuinely in dispute and the moving party is entitled to judgment as a matter of law. Cassesso v. Comm’r of Correction, 390 Mass. 419, 422 (1983); Community National Bank v. Dawes, 369 Mass. 550, 553 (1976); Mass.R.Civ.P. 56(c). The moving party bears the burden of affirmatively demonstrating the absence of a triable issue “and [further,] that the moving party is entitled to judgment as a matter of law.” Pederson v. Time, Inc., 404 Mass. 14, 16-17 (1989). In assessing a Rule 56 motion, “[t]he evidence of the non-movant [here, Valenti] is to be believed and all justifiable inferences are to be drawn in [her] favor ."Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255 (1986) (quoted with approval in G.S. Enterprises, Inc. v. Falmouth Marine, Inc., 410 Mass. 262, 263 (1991)). “The nonmoving party may not simply rest on pleadings, but his response, by affidavits or as otherwise provided in this rule, must set forth specific facts showing that there is a genuine issue for trial.” Correllas v. Viveiros, 410 Mass. 314, 317 (1991).

The parties agree that the focus of the instant matter is upon the definition of total disability under the 1992 policy. Specifically, the parties are in dispute as to whether Dr.

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Related

Anderson v. Liberty Lobby, Inc.
477 U.S. 242 (Supreme Court, 1986)
Pederson v. Time, Inc.
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572 N.E.2d 7 (Massachusetts Supreme Judicial Court, 1991)
Community National Bank v. Dawes
340 N.E.2d 877 (Massachusetts Supreme Judicial Court, 1976)
Cassesso v. Commissioner of Correction
456 N.E.2d 1123 (Massachusetts Supreme Judicial Court, 1983)
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Bluebook (online)
14 Mass. L. Rptr. 373, Counsel Stack Legal Research, https://law.counselstack.com/opinion/valenti-v-paul-revere-life-insurance-masssuperct-2002.